Bill · S. 5321· Senate(119-S-5321)
HCBS Access Act
- Introduced
- 8/6/2026
- Last activity
- 8/6/2026 — Read twice and referred to the Committee on Finance.
- Sponsored by
- Ben Luján
- Cosponsors
- - 18 - 0
- Introduced
- In Committee
What this bill would do
The HCBS Access Act aims to require and expand access to home and community-based services (HCBS) under the Medicaid program. It seeks to eliminate waiting lists for these services to prevent unnecessary institutionalization for older adults and people with disabilities. The bill provides for grants to recruit, train, and retain the direct care workforce and offers support for family caregivers. It also modifies Medicaid eligibility and mandates the creation of an ombudsman office in each state. Additionally, it establishes a national technical assistance center to support the direct care workforce.
Yes· 3 of 45
Would people over 65 be better off under this?+10
Significantly increases access to home and community-based services for older adults.
Would people with disabilities be better off under this?+10
Removes waiting lists and mandates coverage for a wide range of community-based services.
Would retired people be better off under this?+10
Greatly expands the ability of retirees to receive long-term care at home rather than in institutions.
The opposite· 3 of 4
Does this reduce what the federal government spends?-6
Authorizes substantial new appropriations for workforce grants and technical assistance.
Does this leave more decisions to the states?-4
Reduces state flexibility by making HCBS a mandatory benefit.
Does this reduce what the federal government owes?-4
Increases federal spending through new grants and a 100% FMAP for HCBS.
Who it would affect, and how
Potential Positive Impacts for People
- Increased Access to Care: The bill requires Medicaid coverage for HCBS to eliminate waiting lists and ensure people with disabilities and older adults can live in their communities (Section 101).
- Broad Range of Covered Services: It specifies a wide array of supported services, including personal assistance, respite services, housing support, and nutrition services (Section 102(a)(2)).
- Support for Family Caregivers: The act requires states to provide supports for family caregivers, such as respite care and potentially paid caregiving (Section 102(d)(2)(C)).
- Improved Worker Wages and Benefits: It mandates that payment rate increases be proportionately passed through to direct care workers and requires states to ensure compensation is sufficient to recruit and retain workers (Section 102(d)(2)(D)-(E)).
- Financial Protections: The bill makes permanent the protection against spousal impoverishment for HCBS recipients (Section 108) and requires the withdrawal of certain medical assistance liens (Section 110).
- Workforce Development: It authorizes grants for the recruitment, training, and professional advancement of direct care professionals and managers (Section 303(a)(2)).
Potential Negative Impacts for People
- Wait Period for Benefits: The mandatory benefit and certain eligibility modifications do not take effect until the first calendar quarter that begins on or after five years from the date of enactment (Section 102(b)(2)).
- Eligibility Restrictions: Access to these services is limited to "eligible individuals" who must have a functional impairment expected to last at least 90 days (Section 102(a)(2)(3)(A)(i)).
- Income Caps: Some eligibility for the expanded services is capped at 150 percent of the poverty line or 300 percent of the supplemental security income benefit rate, depending on the category (Section 103(1)(A)(i)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For People With Disabilities+10Good For Retirees+10Good For Seniors+10Good For Low Income Households+9Good For Women+8Good For African Americans+7Good For Children+7Good For Hispanic Americans+7Good For Native Americans+7Good For Union Workers+7Good For Immigrants+6Good For L G B T Q Community+6Good For Men+6Good For Middle Aged+6Good For Rural Residents+6Good For Urban Residents+6Good For Veterans+6Good For White Americans+6Good For Young Adults+6Good For Asian Americans+5Good For Middle Class Households+4Good For Students+3
- Social Issues And Justice
- Improves Disability Rights+10Improves Poverty Reduction+7Improves Affordable Housing+6Improves Racial Equity+6Reduces Homelessness+6Improves Gender Equality+5Improves L G B T Q Rights+5
- Healthcare
- Improves Healthcare Access+10Increases Medicaid Funding+9Improves Mental Health Access+6Reduces Hospital Costs+4Improves Veterans Healthcare+3Increases Research Funding+3
- Governance And Ideology
- Increases Federal Power+6Improves Government Transparency+5Improves Due Process+4Increase States Rights-4
- Environment Energy And Infrastructure
- Improves Rural Development+4Improves Public Transit+3
- Economy And Finance
- Increases Job Creation+7Improves Union Protections+5Improves Consumer Protection+4Improves Economic Growth+3Reduces Government Spending-6Reduces National Debt-4Improves Fiscal Responsibility-3
- National Security And Foreign Policy
- Improves Veterans Benefits+4
- 9/30/2026
- 1 Cosponsor added.
- 9/29/2026
- 1 Cosponsor added.
- 9/14/2026
- 1 Cosponsor added.
- 8/7/2026
- 1 Cosponsor added.
- 8/6/2026
- Read twice and referred to the Committee on Finance.
- 15 Cosponsors added.
- Introduced in Senate
2 bills Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Angela AlsobrooksDemocrat · Maryland
Tammy BaldwinDemocrat · Wisconsin
Richard BlumenthalDemocrat · Connecticut
Christopher CoonsDemocrat · Delaware
Tammy DuckworthDemocrat · Illinois
John FettermanDemocrat · Pennsylvania
Kirsten GillibrandDemocrat · New York
Maggie HassanDemocrat · New Hampshire
Timothy KaineDemocrat · Virginia
Andy KimDemocrat · New Jersey
Edward MarkeyDemocrat · Massachusetts
Patty MurrayDemocrat · Washington
Jeff MerkleyDemocrat · Oregon
John ReedDemocrat · Rhode Island
Bernie SandersIndependent · Vermont
Adam SchiffDemocrat · California
Jeanne ShaheenDemocrat · New Hampshire
Chris Van HollenDemocrat · Maryland
Elizabeth WarrenDemocrat · Massachusetts